Legislature passes bill removing age and benefit limits for autism treatment coverage

Iowa residents will soon see expanded insurance coverage for autism treatment following the introduction of Iowa House Bill 5, which aims to eliminate age and benefit limits for individuals diagnosed with autism spectrum disorder. Proposed by the Iowa State Legislature on January 14, 2025, this bill seeks to enhance access to essential healthcare services for individuals of all ages.

Currently, Iowa law mandates that group health plans for public employees cover autism treatment for individuals under 21 years of age, with a maximum benefit of $36,000 per year. House Bill 5 proposes to remove both the age cap and the annual benefit limit, allowing for more comprehensive support for individuals requiring ongoing treatment, regardless of their age.

The bill specifically targets third-party payment contracts and policies, ensuring that coverage for diagnostic assessments and treatments, including applied behavior analysis, is available to all individuals diagnosed with autism. This change is particularly significant for adults who may have previously faced barriers to accessing necessary care due to age restrictions.

Debate surrounding the bill has highlighted concerns about the potential financial implications for insurance providers and the state’s budget. Some lawmakers have expressed worries that removing the benefit cap could lead to increased costs for insurers, which may, in turn, affect premiums for policyholders. However, advocates for autism treatment argue that the long-term benefits of comprehensive care—such as improved quality of life and reduced reliance on state services—far outweigh the initial costs.

As the bill progresses through the legislative process, experts emphasize its potential to significantly impact the lives of many Iowans. By ensuring that individuals with autism can receive necessary treatment throughout their lives, House Bill 5 represents a crucial step toward inclusivity and support for those affected by this condition.

If passed, the provisions of House Bill 5 will take effect for plans delivered or renewed on or after January 1, 2026, marking a pivotal moment in Iowa's healthcare landscape. The outcome of this legislation could set a precedent for other states considering similar reforms, highlighting the importance of accessible healthcare for all individuals, regardless of age.